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Attending Heart School and long-term outcome after myocardial infarction: A decennial SWEDEHEART registry study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.ORCID iD: 0000-0002-1473-4916
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.ORCID iD: 0000-0002-1591-7407
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.ORCID iD: 0000-0002-4140-1981
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
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2020 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 27, no 2, p. 145-154Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Heart School is a standard component of cardiac rehabilitation after myocardial infarction in Sweden. The group-based educational intervention aims to improve modifiable risks, in turn reducing subsequent morbidity and mortality. However, an evaluation with respect to mortality is lacking.

AIMS: Using linked population registries, we estimated the association of attending Heart School with both all-cause and cardiovascular mortality, two and five years after admission for first-time myocardial infarction.

METHODS: Patients with first-time myocardial infarction (<75 years) were identified as consecutively registered in the nationwide heart registry, SWEDEHEART (2006-2015), with >99% complete follow-up in the Causes of Death registry for outcome events. Of 192,059 myocardial infarction admissions, 47,907 unique patients with first-time myocardial infarction surviving to the first cardiac rehabilitation visit constituted the study population. The exposure was attending Heart School at the first cardiac rehabilitation visit 6-10 weeks post-myocardial infarction. Data on socioeconomic status was acquired from Statistics Sweden. After multiple imputation, propensity score matching was performed. The association of exposure with mortality was estimated with Cox regression and survival curves.

RESULTS: After matching, attending Heart School was associated (hazard ratio (95% confidence interval)) with a markedly lower risk of both all-cause (two-year hazard ratio = 0.53 (0.44-0.64); five-year hazard ratio = 0.62 (0.55-0.69)) and cardiovascular (0.50 (0.38-0.65); 0.57 (0.47-0.69)) mortality. The results were robust in several sensitivity analyses.

CONCLUSIONS: Attending Heart School during cardiac rehabilitation is associated with almost halved all-cause and cardiovascular mortality after first-time myocardial infarction. The result warrants further investigation through adequately powered randomised trials.

Place, publisher, year, edition, pages
2020. Vol. 27, no 2, p. 145-154
Keywords [en]
Patient education, cardiac rehabilitation, cardiovascular disease, prognosis, secondary prevention
National Category
Cardiac and Cardiovascular Systems Health Sciences
Research subject
Cardiology; Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-400114DOI: 10.1177/2047487319871714ISI: 000490098000001PubMedID: 31514507OAI: oai:DiVA.org:uu-400114DiVA, id: diva2:1380935
Funder
Swedish Heart Lung Foundation, 2016-0463U‐Care: Better Psychosocial Care at Lower Cost? Evidence-based assessment and Psychosocial Care via Internet, a Swedish Example, 2009-1093Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2020-04-06Bibliographically approved

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Wallert, JohnOlsson, Erik M. G.Pingel, RonnieNorlund, FredrikaBurell, GunillaHeld, Claes

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Wallert, JohnOlsson, Erik M. G.Pingel, RonnieNorlund, FredrikaBurell, GunillaHeld, Claes
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Clinical Psychology in HealthcareDepartment of StatisticsDepartment of Public Health and Caring SciencesUCR-Uppsala Clinical Research CenterCardiology
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European Journal of Preventive Cardiology
Cardiac and Cardiovascular SystemsHealth Sciences

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